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Mineralocorticoid Excess and Hypertension: Review

Year 2009, Volume: 3 Issue: 2, 135 - 144, 26.07.2009

Reyhan Ersoy

Abstract

Conditions resulting from mineralocorticoid excess come either from excess mineralocorticoid or increased mineralocorticoid activity. Secretion of mineralocorticoid hormones is regulated by renin-angiotensin-aldosterone axis and potassium. Hyperaldosteronizm plays a role in 0.5-2% etiology of all hypertensive cases. In most cases nonspecific symptoms of hypertension are seen. Hypokalemia related neuromuscular signs like muscle weakness, malaise, paresthesia are associated to these symptoms. Spontaneous hypokalemia and hypertension support the mineralocorticoid excess. The evaluation of a patient whom hyperaldosteronism is suggested has several distinct stages. The first step entails confirmation that hyperaldosteronism is present or it is not present. The next step involves tests to differentiate primary from secondary causes of hyperaldosteronism and tests to determine subtypes of primer hyperaldosteronism. This paper will review the conditions of mineralocorticoid excess, diagnostic tests and therapy modalities.

Keywords

Mineralocorticoid excess hypertension hypokalemia

References

  • 1. White PC. Disorders of aldosterone biosynthesis and action. N Engl J Med 1994;331: 250-8.
  • 2. Burl R. Don, MD, Joan C. Lo, MD. Endocrin hypertension. In: Gardner GD, Shoback D, ed. Lange Medical Book, Greenspan’s Basic and Clinical Endocrinology. New York: McGraw-Hill; 2007. p.396-420.
  • 3. Connell JM, MacKenzie SM, Freel EM, Fraser R, Davies E. A lifetime of aldosterone excess: long-term consequences of altered regulation of aldosterone production for cardiovascular function. Endocr Rev 2008;29:133-54.
  • 4. Chen SY, Bhargava A, Mastroberardino L, Meijer OC, Wang J, Buse P, Firestone GL, et al. Epithelial sodium channel regulated by aldosterone-induced protein sgk. Proc Natl Acad Sci USA 1999;96:2514-9.
  • 5. Catena C, Colussi G, Lapenna R, Nadalini E, Chiuch A, Gianfagna P, et al. Long-term cardiac effects of adrenalectomy or mineralocorticoid antagonists in patients with primary aldosteronism. Hypertension 2007;50:911-8.
  • 6. Conn JW, Louis LH. Primary aldosteronism: a new clinical entity. Trans Assoc Am Physicians. 1955;68:215-33.
  • 7. Schwartz GL, Turner ST. Screening for primary aldosteronism in essential hypertension: diagnostic accuracy of the ratio of plasma aldosterone concentration to plasma renin activity. Clin Chern 2005;51:386-94.
  • 8. Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf). 2007;66:607-18.
  • 9. Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, et al. A prospective study of the prevalence of primary aldosteronism in 1125 hypertensive patients. J Am Coll Cardiol 2006;48:2293-300.
  • 10. Gill JR. Hyperaldosteronism. In: Becker KL, ed. Principles and Practice of Endocrinology and Metabolism. Philadelphia: Lippincott Williams & Wilkins; 2001. p.773-84.
  • 11. Kaplan NM. Kaplan’s Hypertension. Philadelphia: Lippincott Williams & Wilkins; 2002. p.455-91.
  • 12. Mulatero P, Morello F, Veglio F. Genetics of primary aldosteronism. J Hypertens 2004;22: 663-70.
  • 13. Mulatero P. A New Form of Hereditary Primary Aldosteronism: Familial Hyperaldosteronism Type III. J Clinical Endoc Metabolism 2008; 93;2972-74.
  • 14. Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008;93:3266-81.
  • 15. Seifarth C, Trenkel S, Schobel H, Hahn EG, Hensen J. Influence of antihypertensive medication on aldosterone and renin concentration in the differential diagnosis of essential hypertension and primary aldosteronism. Clin Endocrinol (Oxf) 2002;57:457-65.
  • 16. Young WF Jr, Klee GG. Primary aldosteronism. Diagnostic evaluation. Endocrinol Metab Clin North Am 1988;17:367-95.
  • 17. Mulatero P, Milan A, Fallo F, Regolisti G, Piz-zolo F, Fardella C, et al. Comparison of confirmatory tests for the diagnosis of primary aldosteronism. J Clin Endocrinol Metab 2006;91:2618-23.
  • 18. Lim PO, Farquharson CA, Shiels P, Jung RT, Struthers AD, MacDonald TM. Adverse cardiac effects of salt with fludrocortisone in hypertension. Hypertension 2001;37:856-61.
  • 19. Young Jr WF. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med 2007;356:601-10.
  • 20. Young WF Jr, Klee GG. Primary aldosteronism. Diagnostic evaluation. Endocrinol Metab Clin North Am 1988;17:367-95.
  • 21. Nwariaku FE, Miller BS, Auchus R, Holt S, Watumull L, Dolmatch B, et al. Primary hyperaldosteronism: effect of adrenal vein sampling on surgical outcome. Arch Surg 2006;141:497-503.
  • 22. Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, van Heerden JA. Role for adrenal venous sampling in primary aldosteronism. Surgery 2004;136:1227-35.
  • 23. Young WF, Stanson AW. What are the keys to successful adrenal venous sampling (AVS) in patients with primary aldosteronism? Clin Endocrinol (Oxf) 2009;70:14.
  • 24. Mansoor GA, Malchoff CD, Arici MH, Karimed-dini MK, Whalen GF. Unilateral adrenal hyperplasia causing primary aldosteronism: limitations of 1-131 norcholesterol scanning. Am J Hypertens 2002;15:459-64.
  • 25. Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008;93:3266-8.
  • 26. Meyer A, Brabant G, Behrend M. Long-term follow-up after adrenalectomy for primary aldosteronism. World J Surg 2005;29:155-9.
  • 27. Lim PO, Jung RT, MacDonald TM. Raised aldosterone to renin ratio predicts antihypertensive efficacy of spironolactone: a prospective cohort follow-up study. Br J Clin Pharmacol 1999;48:756-60.
  • 28. Sica DA. Pharmacokinetics and pharmacodynamics of mineralocorticoid blockin-g agents and their effects on potassium homeostasis. Heart Fail Rev 2005;10:23-29.
  • 29. Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrimol (Oxfl 2007;66:607-18.
  • 30. Garovic VD, Hilliard AA, Turner ST. Monc-genic forms of low-renin hypertension. Nâ Clin Pract Nephrol 2006;2:624-30.
  • 31. Biglieri EG, Kater CE. Mineralocorticoids ii congenital adrenal hyperplasia. J Steroii Biochem Mol Biol1991;40:493-9.
  • 32. Palmer BF, Alpern RJ. Liddle's syndrome. An J Med 1998;104:301-9.
  • 33. Wilson FH, Disse-Nicodeme S, Choate K/, Ishikawa K, Nelson-Williams C, Desitter I, eta. Human hypertension caused by mutations n WNK kinases. Science 2001 ;10;293i: 1107-12
  • 34. Mune T, Rogerson FM, Nikkilâ H, Agiarwal AF, White PC. Human hypertension caused b mutations in the kidney isozyme off 11 betr hydroxysteroid dehydrogenase. Nlat Gemt 1995;10:394-9.
  • 35. Geller DS, Farhi A, Pinkerton N, Fradley fl, Moritz M, Spitzer A, Meinke G, et al. Activa-ing mineralocorticoid receptor mutaition in h-pertension exacerbated by pregnane. Science 2000;289:119-23.

Mineralokortikoid Fazlalığı ve Hipertansiyon

Year 2009, Volume: 3 Issue: 2, 135 - 144, 26.07.2009

Reyhan Ersoy

Abstract

Mineralokortikoid fazlalığı ile seyreden durumlar, otonom olarak mineralokortikoid aşırı şahmına ya da mineralokortikoid aktivite artışına bağlı gelişir. Mineralokortikoidlerin ana regülas-yon sistemi renin- angiotensin- aldosteron aksı ve potasyumdur. Hipertansif olguların %0.5-2’de eti-yolojide hiperaldosteronizm rol oynar. Pek çok hastada nonspesifik semptomlarla karakterize hipertansiyon vardır. Buna hipokalemiye bağlı halsizlik, kas güçsüzlüğü ve parestezi gibi nöromüs-küler belirtiler eşlik edebilir. Spontan hipokalemi ve hipertansiyon mineralocorticoid fazlalığını destekler. Hiperaldosteronizmli hastanın değerlendirilmesi birçok farklı aşamaları gerektirir. Öncelikle hiperaldosteronizmin doğrulanması gereklidir. Daha sonraki evre primer ve sekonder hipe-raldosteronizmin ayırıcı tanısı için yapılan testleri ve primer aldosteronizmin alt tiplerinin belirlenmesi için yapılan testleri kapsar. Bu makalede mineralocorticoid artışına neden olan durumlar, tanısal testler ve tedavi yaklaşımları gözden geçirilecektir.

Dr. Ayten OGUZ, Dr. Reyhan ERSOY

Keywords

Mineralokortikoid fazlalığı hipertansiyon hipokalemi

References

  • 1. White PC. Disorders of aldosterone biosynthesis and action. N Engl J Med 1994;331: 250-8.
  • 2. Burl R. Don, MD, Joan C. Lo, MD. Endocrin hypertension. In: Gardner GD, Shoback D, ed. Lange Medical Book, Greenspan’s Basic and Clinical Endocrinology. New York: McGraw-Hill; 2007. p.396-420.
  • 3. Connell JM, MacKenzie SM, Freel EM, Fraser R, Davies E. A lifetime of aldosterone excess: long-term consequences of altered regulation of aldosterone production for cardiovascular function. Endocr Rev 2008;29:133-54.
  • 4. Chen SY, Bhargava A, Mastroberardino L, Meijer OC, Wang J, Buse P, Firestone GL, et al. Epithelial sodium channel regulated by aldosterone-induced protein sgk. Proc Natl Acad Sci USA 1999;96:2514-9.
  • 5. Catena C, Colussi G, Lapenna R, Nadalini E, Chiuch A, Gianfagna P, et al. Long-term cardiac effects of adrenalectomy or mineralocorticoid antagonists in patients with primary aldosteronism. Hypertension 2007;50:911-8.
  • 6. Conn JW, Louis LH. Primary aldosteronism: a new clinical entity. Trans Assoc Am Physicians. 1955;68:215-33.
  • 7. Schwartz GL, Turner ST. Screening for primary aldosteronism in essential hypertension: diagnostic accuracy of the ratio of plasma aldosterone concentration to plasma renin activity. Clin Chern 2005;51:386-94.
  • 8. Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrinol (Oxf). 2007;66:607-18.
  • 9. Rossi GP, Bernini G, Caliumi C, Desideri G, Fabris B, Ferri C, et al. A prospective study of the prevalence of primary aldosteronism in 1125 hypertensive patients. J Am Coll Cardiol 2006;48:2293-300.
  • 10. Gill JR. Hyperaldosteronism. In: Becker KL, ed. Principles and Practice of Endocrinology and Metabolism. Philadelphia: Lippincott Williams & Wilkins; 2001. p.773-84.
  • 11. Kaplan NM. Kaplan’s Hypertension. Philadelphia: Lippincott Williams & Wilkins; 2002. p.455-91.
  • 12. Mulatero P, Morello F, Veglio F. Genetics of primary aldosteronism. J Hypertens 2004;22: 663-70.
  • 13. Mulatero P. A New Form of Hereditary Primary Aldosteronism: Familial Hyperaldosteronism Type III. J Clinical Endoc Metabolism 2008; 93;2972-74.
  • 14. Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008;93:3266-81.
  • 15. Seifarth C, Trenkel S, Schobel H, Hahn EG, Hensen J. Influence of antihypertensive medication on aldosterone and renin concentration in the differential diagnosis of essential hypertension and primary aldosteronism. Clin Endocrinol (Oxf) 2002;57:457-65.
  • 16. Young WF Jr, Klee GG. Primary aldosteronism. Diagnostic evaluation. Endocrinol Metab Clin North Am 1988;17:367-95.
  • 17. Mulatero P, Milan A, Fallo F, Regolisti G, Piz-zolo F, Fardella C, et al. Comparison of confirmatory tests for the diagnosis of primary aldosteronism. J Clin Endocrinol Metab 2006;91:2618-23.
  • 18. Lim PO, Farquharson CA, Shiels P, Jung RT, Struthers AD, MacDonald TM. Adverse cardiac effects of salt with fludrocortisone in hypertension. Hypertension 2001;37:856-61.
  • 19. Young Jr WF. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med 2007;356:601-10.
  • 20. Young WF Jr, Klee GG. Primary aldosteronism. Diagnostic evaluation. Endocrinol Metab Clin North Am 1988;17:367-95.
  • 21. Nwariaku FE, Miller BS, Auchus R, Holt S, Watumull L, Dolmatch B, et al. Primary hyperaldosteronism: effect of adrenal vein sampling on surgical outcome. Arch Surg 2006;141:497-503.
  • 22. Young WF, Stanson AW, Thompson GB, Grant CS, Farley DR, van Heerden JA. Role for adrenal venous sampling in primary aldosteronism. Surgery 2004;136:1227-35.
  • 23. Young WF, Stanson AW. What are the keys to successful adrenal venous sampling (AVS) in patients with primary aldosteronism? Clin Endocrinol (Oxf) 2009;70:14.
  • 24. Mansoor GA, Malchoff CD, Arici MH, Karimed-dini MK, Whalen GF. Unilateral adrenal hyperplasia causing primary aldosteronism: limitations of 1-131 norcholesterol scanning. Am J Hypertens 2002;15:459-64.
  • 25. Funder JW, Carey RM, Fardella C, Gomez-Sanchez CE, Mantero F, Stowasser M, et al. Case detection, diagnosis, and treatment of patients with primary aldosteronism: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008;93:3266-8.
  • 26. Meyer A, Brabant G, Behrend M. Long-term follow-up after adrenalectomy for primary aldosteronism. World J Surg 2005;29:155-9.
  • 27. Lim PO, Jung RT, MacDonald TM. Raised aldosterone to renin ratio predicts antihypertensive efficacy of spironolactone: a prospective cohort follow-up study. Br J Clin Pharmacol 1999;48:756-60.
  • 28. Sica DA. Pharmacokinetics and pharmacodynamics of mineralocorticoid blockin-g agents and their effects on potassium homeostasis. Heart Fail Rev 2005;10:23-29.
  • 29. Young WF. Primary aldosteronism: renaissance of a syndrome. Clin Endocrimol (Oxfl 2007;66:607-18.
  • 30. Garovic VD, Hilliard AA, Turner ST. Monc-genic forms of low-renin hypertension. Nâ Clin Pract Nephrol 2006;2:624-30.
  • 31. Biglieri EG, Kater CE. Mineralocorticoids ii congenital adrenal hyperplasia. J Steroii Biochem Mol Biol1991;40:493-9.
  • 32. Palmer BF, Alpern RJ. Liddle's syndrome. An J Med 1998;104:301-9.
  • 33. Wilson FH, Disse-Nicodeme S, Choate K/, Ishikawa K, Nelson-Williams C, Desitter I, eta. Human hypertension caused by mutations n WNK kinases. Science 2001 ;10;293i: 1107-12
  • 34. Mune T, Rogerson FM, Nikkilâ H, Agiarwal AF, White PC. Human hypertension caused b mutations in the kidney isozyme off 11 betr hydroxysteroid dehydrogenase. Nlat Gemt 1995;10:394-9.
  • 35. Geller DS, Farhi A, Pinkerton N, Fradley fl, Moritz M, Spitzer A, Meinke G, et al. Activa-ing mineralocorticoid receptor mutaition in h-pertension exacerbated by pregnane. Science 2000;289:119-23.
There are 35 citations in total.

Details

Primary Language Turkish
Subjects Endocrinology
Journal Section Reviews
Authors

Reyhan Ersoy

Publication Date July 26, 2009
Published in Issue Year 2009 Volume: 3 Issue: 2

Cite

APA Ersoy, R. (2009). Mineralokortikoid Fazlalığı ve Hipertansiyon. Türk Tıp Dergisi, 3(2), 135-144.
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